Tuesday, June 14, 2011

Running FAQs 2011

I recruited two! fresh maggots just yesterday (don’t let me down, J and S, and to S in particular: SLOW DOWN), and that and Kylie and procrastination have inspired me to open the floor for your running questions. I’ll take them from the comments and put them up here. Ask away.

Q: I’ve been running the same 5k distance for several years now, about 3 times a week. It takes me 30 minutes. I have recently started adding some weight training on non-running days, which is (I think) helping the running. I’m going a little faster, I think, or feeling a bit stronger when I run, at least. So my question is, what should I do to break out of the same plodding 5k rut? Add distance or try picking up the pace? Or a mixture?

A: I think you mean add time, not distance. Picking up the pace and adding time both will add distance. A mixture, but only one thing at a time. You can add about 10 percent to either per week if you have a good solid base (i.e., months of steady running, not weeks.) I recommend focusing on extending your running time first. More about this here.
Q: S here! Today was Day 2 of Camp Cut-It-Up, in which I transform from a squishy, weak maggot to a shiny, fast, hard-shelled house fly. Today I went more slowly than yesterday, only “running“ half a block at a time, then walking for a few minutes so I wouldn’t die. My question: why do I have to spit every couple blocks, and where the f- is all this saliva/phlegm coming from? My other question: my lower back hurts. Am I running wrong?

A: Dammit, S, I just KNEW you were going to be trouble. Yes, you're running wrong. #1: you are trying to run every day, violating Rule 3, run every OTHER day; #2, you are going too fast, which I know because your salivary glands are rebelling. That happens when you overexert. Parasympathetic/sympathetic balance, mumble mumble. As for your back, you need to strengthen your abdominal muscles. Do that on the days you're not running, and while you're running, suck it in.
Q: I get migraines after running. It happens more often in warm weather. I would really like to increase the amount of exercise I do but the headaches are so frustrating! Especially since I feel fine while running. Going longer than 25 minutes pretty much guarantees the migraine. I have a prescription that works but I don't want to have to take it every time I work out.

A: Exercise-induced migraines are thought to be related to two things: water/electrolyte balance, and that during exercise, your blood vessels expand, and when you stop, they contract, and blood vessel expansion and constriction in the brain are what goes on during a migraine. Try these four things: 1) start your run especially slowly, so as to ease your blood vessels into the activity; 2) drink a sports drink BEFORE you run (generally not useful, but for this it may be) and DON’T drink a lot of water immediately after; 3) take or drink some caffeine before you run; and 4) take a good solid dose of ibuprofen or naproxen at least half an hour before you run. Eventually you may find that the exercise gets your cerebral vessels into shape and decreases the headaches. (It’s ok to use your migraine meds up to twice a week, but yeah, sucks to have to do it every time.)
Q: My heart rate stays high after a run (130) and then drops to 90 in one beat. Massaging my neck fixes it so I do this immediately after my run. I figure better to be fit with an arrhythmia than be unfit. Is that a good attitude or should I stop and see “someone”? Last doctor I mentioned it to just said “stop running.”

A: Whoa. MAJOR issue here. Not the high heart rate itself, but that it sounds like you have an SVT (supraventricular arrhythmia) that resolves with carotid massage, a “vagal maneuver.” Can be a very minor thing, but this is something you DO need to see a cardiologist about. Just stopping running is definitely not the answer, since you could have this with any exertion, and if it’s a dangerous arrhythmia, you need to find that out.
Q: I so long to be a maggot! I started out fit, but after a 7 year hiatus I am fighting my way back at 47. What’s a good strategy for managing your heart rate? I run with a heart rate monitor so I can avoid overdoing it, but 60 seconds into what I perceive to be a very slow run my heart rate kicks it up to the high 160’s. So I drop back to a fast walk until I hit 130 and then run for 30 seconds … and then, bing — 160’s again. Maybe I need a freshly laid fly egg program before I graduate to maggothood!

A: Ditch the heart rate monitor. There is no point in “managing” your heart rate. As in the answer above, it’s not the number that matters but the way you feel. If you are breathless, you are running too fast, whatever your heart rate or your speed. As you SLOWLY get back into shape, your heart rate is likely to drift down, but who cares? It’s like measuring your speed, which maggots are not allowed to do until they’ve been running a good long time. (And you ARE a maggot!)
Q: I have a sore spot on the back of my hip where the muscle attaches to my ilia. I noticed it while walking to work a few weeks ago. I started my running program this week, and because of the sore spot, have just walked instead. It’s still not better! Must I lay off it altogether or just keep walking or what? Should I stretch it? Ice it? Take a nap and have another beer? New Maggot J

A: General rule: if it was not caused by running you can run through it, provided that it does not hurt MORE while running. In fact, sounds like yours was caused by walking, so even more reason to run instead. You will probably find that it will hurt at first, then as you get into your run will ease off, then it will be sore after. That’s ok. There are many, many weird little muscle pains that happen, and you will not permanently damage anything by running through them, and they make take weeks to go away. As for stretching/icing/etc., there’s no very good evidence to suggest that these make a real difference, but if it makes you feel better, go ahead. And, why not have all three? Run, then beer, then nap.
Q: I have plantar fasciitis / heel pain, and I can run through it but it’s just no fun. What’s the best approach: keep running on the theory that it will hurt anyway, or take time off?

A: Plantar fasciitis is a bitch, but it does not have to derail your running life, no matter what your doctor says. I don’t have instant cures, but I do have useful knowledge. 1) You do not have to stop running completely, though softer surfaces, less distance, and no hills are not a bad idea. 2) Stretching and foot exercises do help. 3) It almost always lasts for a long, long time (months) no matter what you do, but it WILL go away. 4) I advise staying away from injections, because the complications from them outweigh the benefit (if any) for most people. 5) NSAIDs (ibuprofen, naproxen) help. 6) Cushioning/orthotics can help. Wikipedia has a pretty good page on it.
Q: I am running every day and I have injured myself. What to do?
A: This isn’t an actual question, but it lies beneath several of them. If you write to me that you are having problems of some kind and you are running every day (or even just two days in a row), I want to slap you upside your head, because you have disobeyed instructions and I cannot help you now. Run every OTHER day. It works, people. Exercise causes tiny tears within muscle, and the repair thereof is how you get into shape. It takes approximately 2 days for this cycle to complete, so if you run too soon, you just tear and tear and then you’re hurt and then you’re a Maggot down. (I’m cyber-slapping S, Feral, Scr, and a few others – you know who you are.)
Q: Do you eat before you run? I worry about being lightheaded if I don’t eat or cramps if I do. And can I drink coffee before a run?
A: Eating is tricky, because each person is different. I have an iron stomach, so I can eat a small meal and run half an hour later. Others need a couple of hours to avoid nausea. The other tricky part about eating is what to eat. I cannot have simple sugars at all the days that I run; unless I have a reasonable amount of protein and fat in my system I “bonk,” even on a short run. I can’t be hungry either, for the same reason. You’ll have to learn what you need via trial and error (though avoid simple sugars for sure; they’re not good for you anyway). And you don’t want to eat anything you don’t mind resampling via eructation the duration of your run. Caffeine: yes! It is a potent performance enhancer (a good thing!) and its dehydration danger rep is a myth. (You may need to find a bathroom along the way—it can make you have to pee.) As for when, whenever feels good. On morning runs, I slug coffee just before going out the door, but again, iron stomach.
Q: You’ve written about running not being much of a risk factor for arthritis, but I’m a little worried about it. Last summer I was determined to get my 5K time below 30 minutes, but I noticed that my hips started aching between runs. One day I just walked briskly. The result was the worst hip pain ever. Also, is it true that people with benign ligamentous laxity have a harder time running? I would feel better about my poky pace if I could blame it on my loosely knit joints.
A: I stick by my statements re: running and arthritis. And listen to yourself: your hips started to hurt after you tried to force yourself to go faster, AND they hurt more when you WALKED. You are running proof of the excellence of my advice. As for laxity, I don’t think there is good data, but I noticed a while ago that we avid runners tend to be a stiff lot even before we start. Perhaps having tight connective tissue IS protective against injury. (Bad for childbearing, but I only had to do that once and I run every other day.)
Q: Any advice on running with a dog or a fetus?
A: If anyone has good advice, put it in the comments below, would you? I don’t have much experience with either. I couldn’t run pregnant for a variety of reasons, but I know of many who have. It’s not dangerous if you’re healthy. (Oh and: some veterinarians will tell you that your dog shouldn’t run far. This is silly if you have a healthy dog.)

(Note: I will try to answer at least a question a day, and I’ll try to answer all of them eventually, but not in order. Some are really hard!)

Monday, June 13, 2011

Pretty Ugly

(Started to put the following in the comments after Jess’s, but it got too long.)

Part of the reason I doubt I’ll ever give up this blog – despite a common view that FaceBook punctured the blogosphere (which I don’t think is true; it mainly pulled out the non-anonymous folks, though it did decrease blog comments, maybe because blog commenting is harder) – is how much I learn and grow from it, because of you all. Thoughtful disagreement is invaluable to me.

Answers to some questions: I was comfortable in what I wore to the party; other mothers were more covered up; and, a friend reported, Nana was wearing underwear. Nana did comment on FaceBook, “Why did I wear such a short skirt?” Suggesting there is some insight/struggle/insecurity there too, making me feel a little more ashamed. (A friend from the Pacific Northwest commented back that, well, it is hotter where we are ... )

I realized after my last post that I dress at opposite points on the spectrum for work and non-work. I am practically Amish at work. No bare legs! Errant necklines get the stapler treatment! Bare arms are covered before any patient contact! Occasionally if it’s really, really hot I’ll show toes, but I feel self-conscious about it all day. So for a recent dress-up event involving residents, I pulled the Ugly Pretty Girl move (you know, like in all those movies where the Plain Jane takes off her glasses and baggy clothes and appears at the school dance looking like Halle Berry and OMG, she’s pretty! WHO KNEW?). I wore a sequined silk fuschia halter dress that showed leg (below the knee), and heels, and put on contacts and eye makeup and pinned my hair up. And people seemed astonished. Comments included, “Wow, look at Dr. M, making it happen!” For days afterward residents were coming up to me saying, “You looked good. Like, really good.” Which felt nice.

Clearly I have a hard time with the middle ground, and I still haven’t seen a rule of thumb I can apply to myself. I agree in theory with the idea that everyone should be wearing exactly what they want to wear, and I mostly follow this at home and don’t care much what people think – although honestly? I’d like to be a nudist, and remember this post? Well, I have finally started wearing a shirt – but at work I don’t like wondering if I’m upsetting my patients. The distraction quotient does exist; there is one physician where I work who shows SO MUCH skin every single day that many, many people have asked many other people to “speak to her about it.” I partly like that she dresses that way, but I partly find it insensitive, not least because she is conventionally gorgeous and it seems like she’s showing off rather than being comfortable in her own skin.

I don’t mind being the Pretty Ugly Girl, but I don’t want to be the Mean Girl. Jacq, I think I won’t post her outfit next year.